Clamp implant for posterior arch of the atlas

ABSTRACT

A spinal fusion clamp implant that connects two vertebra, preferably the C1 and C2 vertebra. The clamp implant includes a clamp assembly that connects to the C1 vertebra. The clamp assembly includes at least one superior jaw and at least one inferior jaw. The superior jaw and the inferior jaw are opposedly arranged and clamp onto posterior arch of the C1 vertebra. The clamp implant also includes an implant assembly that connects to the implant used in C2, and a connection system that connects the clamp assembly with said C2 implant assembly.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority from U.S. Provisional Application No.62/522,452, filed on Jun. 20, 2017, and U.S. Provisional Application No.62/645,520, filed on Mar. 20, 2018, the disclosures of which are herebyincorporated herein by reference in their entireties.

FIELD OF THE INVENTION

The present invention relates to the field of spinal fusion fixationdevices. More particularly, the invention relates to a spinal fusionclamp implant that connects a first vertebra (e.g., the C1 vertebra)with a second vertebra (e.g., the C2 vertebra).

BACKGROUND OF THE INVENTION

The first and second cervical spine vertebrae (C1 and C2) are unique dueto the presence of a synovial “pin joint” (referred to as theatlantoaxial joint), compared to the intervertebral discs in the lowercervical spine. As shown in FIG. 1A, the C2 vertebra 2 has a boneystructure called the odontoid 4 which acts as the pin that sits withinthe ring of C1 vertebra 6. The odontoid 4 articulates against theanterior ring of C1 and is held in place by ligamentous structures.Atlantoaxial instability (AAI) occurs when there is excessive motion atthe atlantoaxial joint most commonly caused by traumatic fracture of theodontoid. If left untreated, AAI can cause chronic pain, myelopathy andeven death when even mild additional trauma is sustained to thedestabilized joint segment. Odontoid fractures are classified into threetypes depending on the location of the fracture line in the C2 vertebra.Type II fractures, such as shown in FIG. 1B, are the most common and dueto a higher risk of fracture non-union, surgical treatment isrecommended. However, a surgical approach is not always possible,especially in the elderly patient population, due to concerns related tointraoperative blood loss, operating time, surgical invasiveness andrecovery time. Given these concerns, only approximately 50% of thecurrent elderly patient population is healthy enough to undergo surgeryfor AAI. Even when surgical treatment is possible, deciding the optimaltreatment is not trivial and a common consensus has not yet been reachedin clinical practice.

Posterior spinal fusion, in which an implant construct is used to holdadjacent vertebrae together until they heal into a single piece of solidbone, has become the most common surgical treatment for type II odontoidfractures in elderly patients when surgery is feasible. Since beingintroduced in 2001, the Harms construct has become the standard fixationfor posterior fusion of the atlantoaxial segment due to good constructstability and high fusion rates.

FIGS. 2A and 2B show posterior and lateral views, respectively, of theuse of the Harms construct in atlantoaxial fusion on a model of theupper cervical spine. The Harms construct consists of two polyaxialscrews 14 that are inserted into the lateral masses 10 of C1, connectedby titanium rods 16 to two additional polyaxial screws 18 that areinserted into the pedicles 12 of C2. Cap screws 20 are tightened down onthe rods 16 to lock the construct in place and provide immediatestability to the joint until long term fusion occurs. The surgicalprocedure for implanting the Harms construct is very invasive, requiringa long incision and a dissection all the way down to the C1 lateralmasses 10. The blood loss associated with this surgery tends to be veryhigh due to disturbing the capillaries and venous plexus around thevertebral artery 22 and C2 nerve root 24. Additionally, placement of theC1 lateral mass screw 14 is risky due to the potential for injuring thevertebral artery 22 and often the C2 nerve root 24 is sacrificed to geta safer screw trajectory. Due to these surgical concerns, approximatelyhalf of the elderly patient population is not fit for surgery and mustinstead be treated conservatively with hard collar immobilization,ultimately leading to high fracture non-union rates and a permanentinstability.

Attempts have been made both clinically and experimentally to developnew constructs and surgical techniques that better suit the needs of theC1/C2 segment. For example, Huang et al. (Posterior atlantoaxialfixation: a review of all techniques, The Spine Journal, Vol. 15, 2015,pp. 2271-2281) discusses, inter alia, various C1-C2 atlantoaxialstabilization/fixation techniques involving screws and clamps or hooks,such as C1-C2 apofix clamps, C1 hook combined with a C2 pedicle screw,and a C1 screw combined with C2 hooks. However, these techniques are notsufficiently stable (e.g., clamp slippage occurs frequently), result inpseudarthrosis, and/or are generally difficult to use in surgery. On theother hand, as shown in the posterior and lateral views of FIGS. 3A and3B, respectively, and as reported in Dorward and Wright (Seven Years ofExperience With C2 Translaminar Screw Fixation: Clinical Series andReview of the Literature, Neurosurgery, Vol. 68, No. 6, June 2011, pp.1491-1499), C2 translaminar screws 26 have been used with excellentclinical success to replace C2 pedicle screws 18 in the Harms constructand thus eliminate the risk of a C2 screw injuring the vertebral artery22. Although C2 translaminar screws 26 have reduced risk in posteriorfusion procedures, the surgery remains equally invasive as the Harmsprocedure with regard to blood loss and operating time because of thecontinued use of C1 lateral mass screws 14.

It is therefore desirable to provide a spinal fusion fixation devicethat does not suffer from the above drawbacks.

Advantages of the present invention will become more fully apparent fromthe detailed description of the invention below.

SUMMARY OF THE INVENTION

The present invention in the various embodiments described belowaddresses the problems discussed above and other problems, by providinga spinal fusion clamp implant that connects a first vertebra with asecond vertebra. The clamp implant includes a clamp assembly thatconnects to the first vertebra. The clamp assembly includes a superiorjaw assembly having at least one superior jaw, and includes an inferiorjaw assembly having at least one inferior jaw. The superior jaw andinferior jaw are opposedly arranged and clamp onto the first vertebra.The clamp implant also includes an implant assembly that connects to thesecond vertebra, and a connection system that connects the clampassembly with the implant assembly. In a preferred embodiment, the firstvertebra is the C1 vertebra, and the superior jaw and inferior jaw clamponto the posterior arch of the C1 vertebra.

The present invention advantageously reduces the invasiveness ofatlantoaxial posterior fusion surgeries by providing a clamp implant toreplace C1 lateral mass screws and instead affix to the posterior archof C1. Additional embodiments and additional features of embodiments forthe clamp implant are described below and are hereby incorporated intothis section.

BRIEF DESCRIPTION OF THE DRAWINGS

The features, objects, and advantages of the present disclosure willbecome more apparent from the detailed description set forth below whentaken in conjunction with the drawings in which like referencecharacters identify correspondingly throughout and wherein:

FIG. 1A shows the boney anatomy of the atlantoaxial joint (C1, partiallytransparent to show odontoid placement) and FIG. 1B is a view of the C2vertebra showing a type II odontoid fracture.

FIG. 2A is an upper cervical spine anatomical model, posterior view,showing the Harms construct used in atlantoaxial fusion, and FIG. 2B isa lateral view of the same.

FIG. 3A is an upper cervical spine anatomical model, posterior view,showing a fusion construct that uses C2 translaminar screws, and FIG. 3Bis a lateral view of the same.

FIG. 4A is a posterior view of the clamp implant of the presentinvention used with C2 translaminar screws; FIG. 4B is a lateral view ofthe clamp implant used with C2 translaminar screws; FIG. 4C is aposterior view of the clamp implant used with C2 pedicle screws; andFIG. 4D is a lateral view of the clamp implant used with C2 pediclescrews.

FIGS. 5A and 5B are superior and inferior axial views, respectively, ofthe clamp implant on the C1 posterior arch (polyaxial rods and rod capscrews omitted).

FIG. 6A is a side profile of the clamp implant, showing the saw toothsurface for bone fixation and FIG. 6B shows the detail of the spikedteeth of the jaws, and the porous material between the teeth.

FIGS. 7A is an anterior view of the implant showing independent jawarticulation; FIG. 7B is a side detail of the implant showing the jawlocking mechanism (clamp body and inferior jaw is shown partiallytransparent); FIG. 7C shows the ball joint geometry to allow additionaldegrees of freedom for jaw motion; and FIG. 7D shows the multiple radiustear drop geometry of the socket, and a cutout in the socket.

FIG. 8A shows the polyaxial rod of the present invention with aspherical head; FIG. 8B shows the socket articulation for the polyaxialrod; FIG. 8C shows the polyaxial rod insertion into the clamp body; andFIG. 8D shows the locking of the polyaxial rod into the socket bytightening the rod cap screw.

FIG. 9A shows the final fusion construct created with the C1 clampimplant and C2 translaminar screws; FIG. 9B shows the final fusionconstruct created with the C1 clamp implant and C2 pedicle screws; andFIG. 9C shows the final fusion construct created with the C1 clamp, C2pedicle screws and a C0 plate.

FIG. 10 shows the instrumentation used in conjunction with the implantof the present invention.

FIG. 11A shows an alternative inserter tool with an axial handle and noangular offset; FIG. 11B shows an end view of the alternative insertertool with a window in the handle for screwdriver access; and FIG. 11Cshows the alternative inserter tool with the clamp implant attached tothe distal end of the tool.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

In the following detailed description, reference is made to certainembodiments. This detailed description is merely intended to teach aperson of skill in the art further details for practicing preferredaspects of the present teachings and is not intended to limit the scopeof the claims. Therefore, combinations of features disclosed in thefollowing detailed description may not be necessary to practice theteachings in the broadest sense, and are instead taught merely todescribe particularly representative examples of the present teachings.It is to be understood that other embodiments may be employed and thatvarious structural changes may be made.

With reference to FIGS. 4A-9C, the present invention is directed to aclamp implant 100 configured to connect a first vertebra (preferably theC1 vertebra 6) with a second vertebra (preferably the C2 vertebra 2).The clamp implant 100 comprises: (i) a clamp assembly 110 (FIG. 6A)configured to connect to the C1 vertebra 6, (ii) an implant assembly,such as translaminar screws 26 or pedicle screws 28, to connect to theC2 vertebra 2, and a connection system 150 that connects the clampassembly 110 with the implant assembly, i.e., translaminar screws 26 orpedicle screws 28.

Clamp assembly 110 comprises a superior jaw assembly 115 of two superiorjaws 115 a, and an inferior jaw assembly 116 of two inferior jaws 116 a.The superior jaws 115 a and the inferior jaws 116 a are opposedlyarranged and are configured to clamp onto the posterior arch 8 of the C1vertebra 6. The jaws of the clamp are concave in shape to conform to thesuperior and inferior sides of the C1 posterior arch. The fixationsurface of the inferior jaw 116 a is designed with less concavity (i.e.,greater radius of curvature) than the superior jaw 115 a, since theinferior side of the C1 posterior arch is generally flatter than thesuperior side. In different implant variations, the concavity of theinferior and superior jaws may be the same. Alternatively, the inferiorand superior jaws may also be designed to have no concavity (i.e, beflat) or may even be designed to have a variety of convex shapes.

As shown in FIGS. 5A and 5B, the inferior jaw assembly 116 has a cutout117 in the midsection which acts as a window for bone graft material topromote long term fusion. The superior jaw assembly 115 has two parts toenhance its grip on the C1 posterior arch 8 that may be slightlynon-symmetrical in its anatomical geometry, as described in furtherdetail below. The gap between the two parts of the superior jaw assembly115 may also act as a window for bone graft material. In an alternativeembodiment, the inferior jaws 116 a can have no bone graft cutout,creating a single, slightly stiffer, inferior jaw. This single inferiorjaw can also be smaller in width to effectively create a three pronged(rather than the current four pronged) clamp that could allow bone graftmaterially to be placed on the lateral sides of the jaw rather than themedial sides.

To avoid injury to the vertebral artery 22 (which sits atop thevertebral groove 23), the lateral footprint distance L₁ of the superiorjaws 115 a is less than the lateral footprint distance L₂ of theinferior jaws 116 a. Injury to the vertebral artery 22 is not a concernfor the inferior jaws 116 a, so the L₂ dimension can be larger toprovide additional component stiffness which increases overall implantstability. In different implant variations, the L_(i) and L₂ dimensionscould vary, and L₁ may not be smaller than L₂.

As further shown in FIGS. 5A and 5B, respectively, in the axial(horizontal) plane, the clamp jaws are designed to have a curved cutout119 that follows the C1 posterior arch so that the implant does notprotrude into the spinal canal. Optionally, rounded edges can be addedto these curved cutouts to further reduce the risk of pointed objectsnear the spinal canal.

As shown in FIG. 6, the superior jaws 115 a and the inferior jaws 116 apreferably have a saw tooth surface 185. The saw tooth design preventsthe implant from backing out in the posterior direction. Movement in theanterior direction is not a concern since the body of the clamp butts upagainst the C1 posterior arch 8. In different embodiments of thisdesign, the jaw surface may consist of cylindrical spikes, pyramidspikes, a knurled surface or a porous surface. Such surfaces (includingthe saw tooth surface 185) may produce bone strains that bioactivelyencourage bone ongrowth/ingrowth. A combination of jaw surfaces may alsobe used, such as the case shown in FIG. 6B, where porous surface regions186 are positioned between spike tips 187. The porous surface regionscan be created as part of a three dimensional printing method offabricating the clamp component or by temporarily attaching a metalpowder to the surface regions and then sintering it to provide apermanent fused porous surface structure or by using a plasma sprayingtechnique with a metal powder. Additionally, the jaw surface can includea material attached to it (including porous regions) that helps promotebone ongrowth/ingrowth biochemically, such as hydroxyapatite orhydroxyapatite with tricalcium phosphate. All of the above described jawsurfaces help the jaws grip the C1 posterior arch 8 to minimize oreliminate movement (e.g., micromotion) between the jaw surface and boneof the C1 posterior arch from the time of surgery until the bony fusionis established, thus enhancing overall implant stability.

As shown in the anterior view of FIG. 7A, the two superior jaws 115 aare designed to both articulate and be locked independently of eachother. This allows the implant to adapt to non-symmetric anatomy andstill achieve adequate fixation. To provide articulation, the superiorjaw assembly 115 may comprise a (linear) single axial joint 131 (seeFIGS. 7A and 7B) associated with each of the superior jaws 115 a. Thesingle axial joint 131 allows for single axial movement of the superiorjaw 115 a with respect to the corresponding inferior jaw 116 a.Alternatively, the superior jaw assembly 115 may include a ball joint133 (see FIG. 7C) associated with each of the superior jaws 115 a. Eachball joint 133 allows for multi-axial movement of the associatedsuperior jaw 115 a with respect to the corresponding inferior jaw 116 a.The ball joint geometry allows for additional degrees of motion and abetter fit between the implant and the posterior arch of C1. Additivemanufacturing techniques can be used to manufacture this ball joint as aone step process with no assembly required. In this case, reliefcut-outs (or windows) 160 may be included in the socket of the balljoint geometry to allow for the escape of un-sintered powder (see FIG.7D). The socket of the ball joint may also comprise a multiple radiustear drop geometry, with a larger radius 159 a and a smaller radius 159b, in order to allow more clearance between the ball and socket duringthe additive manufacturing process while still allowing a tightclearance when the ball is seated in the locked position. Standardassembly and manufacturing techniques using CNC's, lathes, precisiongrinding and precision tooling may also be used to create the balljoint.

The superior jaw assembly 115 further includes jaw locking screws 146(see FIGS. 7B and 8B-8D) that can be tightened to lock the superior jaws115 a in place after the implant has been placed on the C1 posteriorarch 8 and fitted to the anatomy. The clamp body has two threaded holesto allow for placement of the jaw locking screws 146. A buttress threadmay be used to prevent loosening of the locking screws. As shown in FIG.7B, the top surface of the jaws that come in contact with the jawlocking screws 146 are designed to act as cam surfaces that provideprogressive closing of the jaws as the jaw locking screws 146 aretightened. The ends of the jaw locking screws 146 are rounded to promotea smooth sliding motion as the jaws 115 a close. Tightening of the jawlocking screws 146 also controls the clamping pressures at the jaw/bonefixation interfaces. In other embodiments of this design, the jawlocking screws 146 can be in line with the center of rotation of thejaws and simply act as set screws. The clamping pressure of the jaws 115a can then be controlled by external tooling, such as pliers, placedaround the jaws. Alternatively, one jaw locking screw (instead of two)could be placed centrally in the body of the clamp to lock both jawssimultaneously.

Alternatively or additionally, in a likewise manner to that describedabove, the two inferior jaws 116 a may be designed so they are capableof independent movement from each other. Thus, the inferior jaw assembly116 may comprise a (linear) single axial joint (not shown) similar tosingle axial joint 131 associated with the inferior jaws 116 a, or aball joint (not shown), similar to ball joint 133 associated with theinferior jaws 116 a. The inferior jaw assembly 116 would then furthercomprise jaw locking screws (not shown), similar to jaw locking screws146, for locking the inferior jaws 116 a in place.

As described in further detail below, an implant assembly, such as C2translaminar screws 26 or pedicle screws 28, is configured to beimplanted into translaminar portions or pedicle portions of the C2vertebra (see FIGS. 4A-4D and 9A-9C).

Connection system 150 comprises a polyaxial connection system comprisinga polyaxial rod 155 with a spherical head 156, and a rod cap screw 161configured to be tightened to apply pressure to the spherical head 156,thereby locking the polyaxial rod 155 in place. More specifically, oncethe clamp 110 has been locked into place on the C1 posterior arch 8,rods 155 are inserted into the clamp to connect the clamp 110 to theimplant used in C2, thus creating the overall clamp implant fusionconstruct. The use of C2 pedicle screws 28 and/or C2 translaminar screws26 has been previously discussed as feasible implant components thatcould be used in conjunction with the C1 clamp 110. However, the C1clamp 110 can be used with any C2 implant component designed to beconnected to the C1 implant component through the use of rods. As shownin FIG. 8A, the rods for the C1 clamp (referred to as polyaxial rods155) have spherical heads so that, prior to tightening of the rod capscrew 161, they can articulate within the polyaxial sockets 158 of theC1 clamp body. The sockets, shown in FIGS. 8C and 8D, are designed toallow ±30° of rod rotation in any direction. Sockets 158 have a bias andallow more rotation in the lateral direction (θ) and less rotation inthe medial direction (β), as shown in FIG. 8B, to provide a better fitwhen pedicle screws are used in C2. As shown in FIG. 7D, sockets 158 canalso have additional windows or cutouts 160 and/or holes to improve theaesthetic appearance of the device as well as reduce the overall bulk ofthe device. The posterior regions of the sockets are threaded to allowfor the rod cap screws 161 to be tightened into place. A buttress threadmay be used to prevent loosening of the rod cap screws. The polyaxialrods 155 are inserted through the bottom of the clamp body (FIG. 8C) andthen slid forward into the sockets when the rod cap screws 161 arethreaded into place (FIG. 8D). The rods 155 are specifically designed tobe inserted in the bottom of the clamp body so that a fully threadedhoop can be maintained for the rod cap screws. This full hoop minimizesdeformation due to the splaying generated during thread tapping and rodcap screw tightening. In another embodiment, slots or cutouts areprovided in the sockets to allow the rods to be inserted from theposterior and/or lateral directions.

Once both rods 155 are placed in the sockets 158, they can be connectedto the C2 implant assembly, such as C2 translaminar screws 26 (FIG. 9A)or C2 pedicle screws (FIG. 9B). Tightening down all of the rod capscrews 161 then locks the clamp implant into place and creates a stablefusion construct.

The clamp implant of the present invention can also be modified for amulti-level fusion that includes the occipital (C0) vertebra. In thiscase, the rod cap screws 161 are replaced with rod cap screws that alsohave polyaxial fixation heads 170 (FIG. 9C). Standard cervical rods 195can then be attached to these polyaxial heads 170 (via tightening ofpolyaxial set screws 171) and connected to a C0 vetebra plate (notshown). Additionally, the construct can be extended below C2 by usinglonger polyaxial rods. These rods may be non-linear to allow betteralignment with the rest of the patient anatomy and/or cervicalinstrumentation. The extended construct may allow for the implant to befixed to a vertebra different than (or in addition to) the C2 vertebra(e.g., the C3 vertebra). Fixation of the implant to another vertebra mayemploy similar or different implantation techniques as those describedin this disclosure for the C2 vertebra.

The clamp implant of the present invention is manufactured from abiocompatible material such as pure titanium, titanium alloy, stainlesssteel or cobalt chromium alloy or a material with potential for boneongrowth/ingrowth such as porous tantalum. Alternatively, oradditionally, porous surfaces with or without coatings such ashydroxyapatite or hydroxyapatite with tricalcium phosphate can be usedon parts of the implant to bioactively encourage bone ongrowth/ingrowth.Some parts of the clamp implant of the present invention can also bemade from a polymer such as PEEK or a polymer composite such as carbonfiber reinforced PEEK. Ceramic inserts can be used for some of thebearing surfaces.

The instrumentation 1000 used in conjunction with the implant, shown inFIG. 10, consists of two torque limited screwdrivers 180, 181 and aninserter tool 182. The implant is first placed on the inserter toolthrough the use of clips, screws, latches or an interference fit. Whileon the inserter tool, the jaws of the implant may be kept open usingclips or latches or through the use of springs and wires that mayconsist of a Nitinol mechanism. The jaws may also be kept open by africtional interference fit between the ball and socket geometry 133previously described. The shaft of the inserter tool can have an angularoffset to allow for better visualization of the posterior arch duringinsertion of the implant. Alternatively, an inserter tool 184 with anaxial handle and no angular offset as shown in FIG. 11A may be used. Inthis case, the handle of the inserter tool will have a plurality ofthrough holes or one larger window 189, shown in FIG. 11B, to allow forthe torque screwdrivers to access the locking screws. The inserter tool182, 184, with clamp implant 100 mounted on the tool (FIG. 11C), is thenused to place the implant on the posterior arch of C1 and hold it inplace until the jaw locking screws are tightened down. During thetightening of the jaw locking screws, the inserter tool 182, 184 alsoacts as the counter torque device. Once the jaws are tight, the insertertool may be used to reduce fractures (if a fracture is present) and/orobtain ideal alignment at the fusion stage before inserting the fullconstruct of the clamp implant. This reduction or fracture alignment isdone while the inserter tool is still connected to the implant, allowingthe handle of the inserter tool to provide better leverage onre-positioning C1. The inserter tool 182 is then removed to free upspace for the remainder of the full construct, i.e., screws 26, 28 to beimplanted in C2, and connection system 150. Upon final tightening of thepolyaxial rods 155, the inserter tool 182, 184 can once again be used asa counter torque device.

The clamp implant of the present invention can be provided in a varietyof sizes to cater to the anatomy of the entire patient population.Three-dimensional printing may be used to fabricate any or all of thecomponents in the manufacture of the clamp implant. Three-dimensionalprinting may also be used to introduce porosity or a lattice structureto encourage bone ingrowth/ongrowth.

Although embodiments are described above with reference to a clampimplant comprising a clamp assembly that, for example, clamps onto theposterior arch of C1, the jaw assemblies of the clamp assembly describedin any of the above embodiments may alternatively clamp onto otherportions of C1 or other vertebra. Such alternatives are considered to bewithin the spirit and scope of the present invention, and may thereforeutilize the advantages of the configurations and embodiments describedabove.

In addition, although embodiments are described above with reference toa clamp implant comprising an implant assembly (e.g., for C2), theimplant assembly described in any of the above embodiments mayalternatively be replaced with a secondary clamp assembly (e.g., of thetypes used for C1 described above). The jaw assemblies for thissecondary clamp assembly may clamp onto any portion of the C2 or othervertebra. Such alternatives are considered to be within the spirit andscope of the present invention, and may therefore utilize the advantagesof the configurations and embodiments described above.

The above description and drawings are only to be consideredillustrative of specific embodiments, which achieve the features andadvantages described herein. Modifications and substitutions to specificprocess conditions may be made. Accordingly, the embodiments of theinvention are not considered as being limited by the foregoingdescription and drawings.

More generally, even though the present disclosure and exemplaryembodiments are described above with reference to the examples accordingto the accompanying drawings, it is to be understood that they are notrestricted thereto. Rather, it is apparent to those skilled in the artthat the disclosed embodiments can be modified in many ways withoutdeparting from the scope of the disclosure herein. Moreover, the termsand descriptions used herein are set forth by way of illustration onlyand are not meant as limitations. Those skilled in the art willrecognize that many variations are possible within the spirit and scopeof the disclosure as defined in the following claims, and theirequivalents, in which all terms are to be understood in their broadestpossible sense unless otherwise indicated.

1. A clamp implant configured to connect a first vertebra with a secondvertebra, the clamp implant comprising: a clamp assembly configured toconnect to the first vertebra, the clamp assembly comprising: a superiorjaw assembly comprising at least one superior jaw; and an inferior jawassembly comprising at least one inferior jaw, wherein the at least onesuperior jaw and the at least one inferior jaw are opposedly arrangedand are configured to clamp onto the first vertebra; an implant assemblyconfigured to connect to the second vertebra; and a connection systemthat connects the clamp assembly with the implant assembly.
 2. The clampimplant of claim 1, wherein the first vertebra is the C1 vertebra, thesecond vertebra is the C1 vertebra, and the superior and inferior jawsare configured to clamp onto the posterior arch of the C1 vertebra. 3.The clamp implant of claim 2, wherein the superior jaw and the inferiorjaw each have a lateral footprint distance, the lateral footprintdistance of the at least one superior jaw being less than the lateralfootprint distance of the at least one inferior jaw.
 4. The clampimplant of claim 1, wherein at least one of the superior and inferiorjaws is concave in shape.
 5. The clamp implant of claim 1, wherein atleast one of the superior and inferior jaws is flat.
 6. The clampimplant of claim 1, wherein at least one of the superior and inferiorjaws has a curved cutout in the axial plane so that the clamp assemblydoes not protrude into the spinal canal.
 7. The clamp implant of claim1, wherein at least one of the superior and inferior jaws has a cutoutwhich acts as a window for bone graft material.
 8. The clamp implant ofclaim 1, wherein at least one of the superior and inferior jaws has asaw tooth surface with spike tips for fixation.
 9. The clamp implant ofclaim 8, further comprising porous surface regions positioned betweenthe spike tips of the saw tooth surface.
 10. The clamp implant of claim9, wherein the surface regions between the saw teeth include a bioactivematerial that helps promote bone ongrowth/ingrowth.
 11. The clampimplant of claim 1, wherein the clamp assembly comprises at least twosuperior jaws or at least two inferior jaws, and at least one superiorjaw or one inferior jaw is capable of independent movement relative tothe other superior or inferior jaw, respectively.
 12. The clamp implantof claim 11, wherein the superior jaw assembly or the inferior jawassembly further comprises a single axial joint associated with thesuperior or inferior jaws, allowing single axial movement of theassociated jaw.
 13. The clamp implant of claim 11, wherein the superiorjaw assembly or the inferior jaw assembly comprises a ball and socketjoint associated with the superior or inferior jaws, allowing poly-axialmovement of the associated jaw.
 14. The clamp implant of claim 13,wherein the socket includes a window, cutout or hole.
 15. The clampimplant of claim 13, wherein the socket has a multiple radius tear dropgeometry with a larger radius and a smaller radius, so that the ball canmove freely within the larger radius of the socket until it is seatedinto the smaller radius of the socket upon locking of the ball andsocket joint.
 16. The clamp implant of claim 11, wherein at least one ofthe superior jaw assembly and the inferior jaw assembly comprises jawlocking screws configured to lock the jaws of the assembly in place. 17.The clamp implant of claim 1, wherein the connection system comprises apolyaxial connection system including a socket in the clamp assembly, apolyaxial rod with a spherical head received in the socket of the clampassembly, and a rod cap screw configured to be tightened to applypressure to the spherical head, thereby locking the polyaxial rod inplace.
 18. The clamp implant of claim 17, wherein the rod cap screw isconfigured to be tightened in a fully threaded hoop in the socket of theclamp assembly, the socket in the clamp assembly comprising a slot orcutout.
 19. The clamp implant of claim 17, wherein the rod cap screwcomprises a poly-axial fixation head configured to lock a C0 connectionrod thereto, and wherein the C0 connection rod is configured to beconnected to a C0 vertebra plate assembly.
 20. The clamp implant ofclaim 1, further comprising an inserter tool having an axial handle withat least one window, the inserter tool acting as both a counter torquedevice and a guide for a torque screwdriver.
 21. The clamp implant ofclaim 20, wherein the handle has an angular offset.